Strategies for managing scarcity and shortages in the supply of drugs, medical devices and other essential goods: insights from the Ecuadorian context

[1] However, this figure is disputed by physicians and healthcare workers who report widespread shortages of even basic supplies, such as antibiotics and syringes.[2] This discrepancy suggests weak oversight and poor inventory monitoring.

A key factor is the fragmentation of public procurement processes. In 2022, over 17,000 small-value purchases were recorded, leading to inefficiencies, inflated costs and reduced transparency.[3] Further compounding the situation are irregularities identified by the Office of the Comptroller General in a 2023 audit, including the awarding of contracts to unqualified suppliers and inadequate storage conditions.[4]

Emergency declarations and updates to the National Medicines Catalogue have served as reactive responses, with limited long-term impact. However, Ecuador requires systemic reform to improve its institutional capacity, data management and accountability.

Consequences of the shortage

These shortages have far-reaching consequences, affecting not only clinical outcomes, but also broader societal wellbeing. From a healthcare perspective, treatment delays for chronic and acute conditions increase avoidable complications, hospitalisations and mortality.[5] Medical staff are often forced to improvise, working without the minimum tools or medications needed for safe and effective care provision.

Economically, the burden shifts to patients and families. Many are forced to purchase medicines privately or resort to informal markets. These alternatives are either costly or unsafe, worsening inequalities and exposing households to financial risk.[6]

Institutionally, chronic shortages undermine trust in public health services. Citizens’ reliance on the private sector grows, deepening inequities and weakening the public system’s legitimacy. These failures signal broader issues related to governance, regulation and fiscal responsibility.

Strategies to address the crisis

To respond effectively to the crisis of shortages and supply chain disruptions in Ecuador’s healthcare system, it is essential to implement a comprehensive set of strategies tailored to different timeframes: short, medium and long term. Each set of actions must be technically sound, realistically implementable and aimed at building a more resilient and equitable system.

Short-term actions

In the immediate term, one of the most urgent priorities is the implementation of real-time monitoring systems for medical supplies and inventories. By leveraging information technologies, these systems will enable continuous tracking of medical supplies at health facilities, facilitate the early detection of items that are out of stock and support more agile and informed decision making. International experiences have demonstrated that early-warning systems significantly reduce the risk of interruptions in the availability of essential medicines and supplies.[7]

Equally important is the optimisation of public procurement processes. Current purchasing models must be revised to strengthen efficiency and transparency, with a shift towards consolidated purchases, standardised procedures and broader use of electronic catalogues and framework agreements. Although these tools already exist in Ecuador, their implementation remains limited and must be expanded and properly managed .[8]

Another urgent measure involves the strategic use of public debt as a financing tool. The government should conduct a thorough financial assessment to identify sustainable sources of funding, prioritising the procurement of essential medicines, devices and medical supplies. This may include debt restructuring, renegotiating interest terms or accessing multilateral loans with favourable conditions. Ensuring timely payments to suppliers would also enhance private sector collaboration and restore trust in the system.[9]

Moreover, public–private partnerships can serve as temporary solutions to improve access. Initiatives like the ‘Medicina Cerca’ programme, which aims to distribute medications through local pharmacies, offer a promising approach to expanding availability during emergencies or in underserved regions.[10] In parallel, the government should strengthen its mechanisms for receiving and distributing international aid, ensuring that donated medical goods are effectively managed, stored and allocated, according to national priorities and standards, in coordination with organisations like the Pan American Health Organisation.[11]

Medium-term reforms

In the medium term, strengthening institutions is key. The National Agency for Regulation, Control and Health Surveillance (Agencia Nacional de Regulation, Control y Vigilance Sanitaria or ARCSA) must be provided with greater autonomy, adequate resources and technical capacity to enforce effective regulation of the pharmaceutical and medical supply market. Its role is critical not only in ensuring quality and safety, but also in streamlining regulatory procedures that often delay product availability.

It is also essential to promote the national production of medicines and medical supplies. Public policies should be designed to create clear incentives for local manufacturing, reducing Ecuador’s dependency on imports and improving national responsiveness in times of crisis. This approach is aligned with the Constitution of Ecuador, which mandates state support in regard to the production of generic medicines that meet the population’s epidemiological needs.[12]

At the same time, the creation of national strategic reserves of essential medicines and supplies should be prioritised. These reserves would serve as a safety net to mitigate the impact of future disruptions or emergencies. Proper management of stockpiles, including regular rotation, replenishment and transparency, would be necessary to ensure their effectiveness .[13]

Additionally, the National List of Essential Medicines (Cuadro Nacional de Medicamentos Básico or CNMB) should be periodically reviewed and updated. This process must be based on current epidemiological evidence, clinical relevance and the input of multidisciplinary expert panels. The aim is to ensure that public procurement aligns with the actual health needs of the population and that the list evolves with emerging demands and scientific advances .[14]

Long-term vision

Over the long term, Ecuador must commit to developing a comprehensive state policy focused on pharmaceutical sovereignty. This entails fostering a national strategy for investment in research, innovation and biotechnology, with the goal of building a robust and sustainable local pharmaceutical industry. Reducing technical and regulatory barriers that are outdated or unnecessarily restrictive is also part of this vision.[15]

Moreover, broader structural reform of the healthcare system is essential to increase its efficiency, equity and capacity to respond to future supply challenges. This includes integrating fragmented services, strengthening the primary level of care at the first point of contact and improving the management of human and financial resources throughout the system. Modernised and well-coordinated healthcare infrastructure will be better equipped to prevent shortages, to respond to public health emergencies and guarantee universal access to the essential medical supplies needed for quality care.[16]

International experiences

Other Latin American countries offer examples for Ecuador. Brazil’s Oswaldo Cruz Foundation (Fundação Oswaldo Cruz or Fiocruz) has made advancements in the public production of generic drugs, reducing the country’s dependence on foreign markets. Uruguay has succeeded by maintaining strategic reserves and evidence-based public procurement systems and, in Colombia, recent public protests over supply failures have triggered calls for systemic reform.[17] These examples illustrate that supply security is not achieved solely through logistics, it requires long-term policy, institutional strength and public investment.

Conclusion

Ecuador’s ongoing crisis involving drug, medical device and essential supply shortages reflects a deep structural dysfunction. Emergency declarations and piecemeal solutions have been proven to be insufficient. A comprehensive, multisectoral strategy , anchored in data, institutional reform and political will,  is needed to guarantee continuous and equitable access to vital health goods.

With targeted short-term interventions, robust medium-term reforms and a long-term vision centred on sovereignty and sustainability, Ecuador can transform this crisis into an opportunity to rebuild trust and resilience within its healthcare system.

Notes